Battling Loneliness: The New Public Health Crisis

There’s a pandemic underway. No, it has nothing to do with viruses or bacteria, or any other pathogen, for that matter. This is a silent pandemic — the pandemic of loneliness. The health consequences, however, are just as serious: social isolation has a bigger impact on mortality than smoking 15 cigarettes a day or having six alcoholic drinks a day. Pick your poison.

It is no surprise, then, that the World Health Organization has declared loneliness a global public health threat. This comes on the heels of the U.S. Surgeon General, Dr. Vivek Murthy, raising the alarm about the harmful impacts of social isolation and a lack of meaningful connections.

So, what do we know about this silent pandemic, and what can we do about it?

Older Adults Are Especially Lonely

One of the key findings of research on loneliness is that elderly populations are especially vulnerable to feeling neglected and alone. Indeed, the experience of loneliness across the lifespan tends to follow a U-shaped curve; it is high during our adolescent years as we grapple with life transitions and questions of identity, it lessens somewhat during middle adulthood when we begin to establish families and solidify social networks (whether this be at work or through contact with other parents), and then it increases again sharply once we move into old age.

While this vertiginous uptick in loneliness with age has a variety of causes, one stands out as a prime culprit: a decline in mobility. The older we grow, the more difficult it becomes to perform routine, everyday tasks like walking up stairs or carrying groceries. Often, these activities end up being cut out wholesale, leaving elderly individuals in a state of physical inactivity that jeopardizes their ability to meet and connect with others. They become “prisoners” in their own bodies.

Hearing loss is another major issue. Language is a gateway to community; more often than not, we get to know one another through conversation. Speaking helps bridge gaps and create bonds. But if a person’s hearing is compromised, one side of the equation breaks down: conversation is as much about listening as it is about talking. Difficulty hearing creates a barrier in communication, risking a steady decline into loneliness. This is reflected by research on the topic, which suggests that loss of hearing increases the risk of social isolation by up to 28%. And this is not an abstract concern: up to two-thirds of older adults experience hearing loss, yet only around 10 to 30% use hearing aids.

Despite the extent of the loneliness epidemic varying from country to country, the U-shaped trajectory represents a global trend. Whether it be in the U.K., Germany, or Australia, most people begin to feel increasingly lonely as they get older. But some groups, it should be pointed out, are at a higher risk of loneliness than others, including women, those with less education, and those with a lower income.

Middle-Aged Adults Are Not Immune

Although loneliness is highest in the elderly, it is becoming more of an issue in middle-aged adults as well — the usual U-shaped trajectory may not hold up much longer. Recent research suggests that this is particularly true for middle-aged Americans, who are consistently lonelier than their European counterparts.

By following 53,000 middle-aged adults from the U.S. and 13 European countries for a total of 18 years, the researchers were able to conclude that Americans rank highest when it comes to feelings of social isolation. Those in Mediterranean Europe and England were not far behind, whereas middle-aged adults in Continental and Nordic Europe —think Germany, Sweden, Norway, and so on— reported the lowest levels of loneliness.

Exactly why Americans are more prone to loneliness was not addressed by the study, but the authors venture a guess: “We think that the loneliness Americans are reporting compared to peer nations comes down to limited social safety nets and to cultural norms that prioritize individualism over community.” Social isolation is closely linked to poverty, and the U.S. is an expert in poverty; in fact, the U.S. has one of the highest poverty rates of all OECD countries.

Another plausible explanation is America’s car-centric culture, which casts aside public space and parks in favor of endless parking lots, behemoth expressways, and suburban developments. In a press release for a study on walkable neighborhoods, James F. Sallis, Ph.D., Distinguished Professor at the Herbert Wertheim School of Public Health, mentions: “Transportation and land-use policies across the U.S. have strongly prioritized car travel and suburban development, so millions of Americans live in neighborhoods where they must drive everywhere, usually alone, and have little or no chance to interact with their neighbors.”

The built environment we live in shapes our interactions. When that environment caters predominantly to car travel, we end up with unwalkable cities and a paucity of public space, both of which hinder the possibilities for social interaction and the development of deep community bonds.

How Harmful Is Loneliness Really?

Alright, so loneliness is on the rise across age groups. That isn’t great, but how worried do we really need to be? Beyond the mental health issues that accompany protracted spells of social isolation, there are also a host of risks to physical well-being.

For one, socially isolated people are at a 25% increased risk of cancer-related mortality and a 32% increased risk of strokes. Risk of heart disease also goes up by a staggering 29%. And as far as dementia is concerned, those who are socially isolated are one and a half times more likely to develop issues than people who report having a rich social life.

Another study found that, in patients with heart failure, those who self-described as feeling very lonely were at a three-fold greater risk of death than their non-lonely counterparts. They were also at a 68% increased risk of being hospitalized over the span of a year.

Clearly, loneliness and social isolation are very tightly linked to poor health outcomes. But as always, trying to separate causation from correlation is a messy business; it is not entirely obvious whether we can say loneliness is causing these health issues. It may be that people with certain health issues or disabilities are more prone to loneliness in the first place, in which case the two simply overlap. Still, it is undeniable that social isolation comes hand-in-hand with an increased risk of mortality. Even if it cannot be said to be causing health issues, it is a flare in the night sky warning us that someone is in dire need of help. We need to start paying attention.

Implications

We need social interaction in the same way we need to eat, and just as hunger is a signal that we are missing something, loneliness is too. It’s our brains’ way of telling us that there’s a deep need that is not being met. In fact, the two even activate the same regions of the brain — when we are lonely, we are being “starved” of meaningful contact. Increasingly, however, the need for contact is being unmet. And the risks that come with prolonged social isolation are starting to show. We are in the middle of another pandemic, only this one is borne out in silence.

As with any health crisis, the first step is acknowledging what is happening. Until we admit that this is an urgent topic in need of attention, nothing will change. The second step is recognizing that this is a systemic problem, meaning that any long-term solutions will lie at the level of policy, not individual intervention. When London eliminated cholera in the late 1800s, it was thanks to changes to waste management, not because of a new pharmaceutical. If we are to address the loneliness pandemic, we need a similar approach. After all, public health issues are social issues, and vice versa.